SHOULDER DISLOCATION AND LABRAL TEARS
If you click on the link above you can download my patient information booklet. It has detailed information with colour pictures. The following is a summary of the important information.
The shoulder is a ball and socket joint but the socket is very shallow. This means that the shoulder is very prone to dislocation – where the ball separates completely from the socket, or subluxation – where the ball separates partly from the socket. To stop this happening, the socket is surrounded by a rim of firm but flexible tissue known as the labrum. This effectively makes the socket deeper and decreases the chance of subluxations or dislocations.The shoulder is also surrounded by a sleeve of tissue known as the capsule. This also helps to hold the shoulder in joint.
When the shoulder is injured a tear may occur in the labrum or the capsule. One type of labral tear is known as a SLAP tear. Very often these tears do not heal properly and the shoulder continues to dislocate. It may only partly dislocate (sublux) which gives a feeling of instability within the shoulder. Sometimes the only symptom may be pain at the extremes of movement or during sport.
If you are experiencing such symptoms you will require a careful examination of your shoulder. X-rays will be required and I will often order a CT scan. Occasionally an MR arthrogram – where dye is injected into the shoulder and an MRI scan performed - is required.
Occasionally physiotherapy can improve the symptoms in your shoulder but if the instability is severe surgery is often required. The tear in the labrum or the capsule is repaired; this can very often be done arthroscopically but as you will read below, sometimes an open operation is needed. Following surgery you will almost always require six weeks in a sling during which time your arm will be completely out of action. You will not be able to use it for anything and that includes driving. You will have some very limited exercises but the most important thing is to wait for the tissue to heal.
Six weeks after your surgery, you can come out of your sling and begin gentle day to day activities. You will have physiotherapy and gradually increase the exercises of your shoulder. Your shoulder will be stiff initially but I would like the movement to return naturally without any stretching exercises. You will be able to do heavy work at four months and all sport at six months.
A common complication with a dislocation is that you can break a piece a bone off either the socket or the ball part of the joint. I will usually perform a CT scan to make sure this has not happened. If you have knocked a piece of bone off then you will require an open (not arthroscopic) operation. This is called a Latarjet procedure where a piece of bone is screwed onto the front of the socket to prevent further dislocations. This is obviously a much bigger operation.
It is extremely important to realize that while surgery for dislocations, subluxations or SLAP tears is very successful, there is still a chance that the shoulder may re-dislocate after even successful surgery. The only way to entirely eliminate the risk of re-dislocation would be to stiffen the shoulder to make it have no movement at all and obviously this would be most undesirable. The chance of re-dislocation is approximately 5% with 1 in 20 people re-dislocating after surgery. It is important that you understand this chance – you should not have surgery if you are not prepared to accept the risk of re-dislocation.
The vast majority of patients will have an excellent result following surgery and almost all patients are able to return to all their normal activities including sport.